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HomeMy WebLinkAboutSHADOWBROOK LT 2SHADOW �6i5 am- q9a 'mm off dor 2woo Recording District: 2024-016017- 0 A KRecording District 301 Anchorage 06iiui�niiii�u�iuiuii�uiuuiuPage rNiof3 uumiAmoCCC X46- 4",Z) e 301 1 Return to: ,^� `2 C vv m J//1 - il.�vv S� �aef � I 'T'HIS COVER SHEET HAS BEEN ADDED TO THIS DOCUMENT TO PROVIDE SPACE FOR THE RECORDING DATA. THIS COVER SHEET APPEARS AS THE FIRST PAGE OF THE DOCUMENT IN THE OFFICIAL PUBLIC RECORD. DO NOT DETACH May 8, 2018 Grant of Ingress/Egress Easement Agreement This Grant of Ingress/Egress Easement Agreement ("Agreement") is made and entered into this 2 l day of 1,,-4 e. , 2024, by and between Karen Coombs-Marcey, as Trustee of the Karen Coombs-Marcey Revocable Trust ("Grantor"), whose address is 113U u �Ja e Z1 f , and [Name of Grantee/Owner of Shadowbrook Lot 1] ("Grantee % whose address is cey Recitals WHEREAS, Grantor is the owner of certain real property located in Anchorage, Alaska, known f as Shadowbrook Lot 2itthe "Servient Estate'), as A a ra fes; and l4 -n 1 Lc. WHEREAS, Grantee is the owner of certain real p� located in Anchorage, Alaska, known as Shadowbrook Lot 1_(the "Dominant Estate"), b*B- attacfiigti�eretci as Lncorporated h ee; and es L K L,m WHEREAS, part of the septic field serving the Dominant Estate is located on the Servient Estate, and Grantee requires ingress and egress across the Servient Estate for the purpose of accessing, maintaining, repairing, and replacing the septic field; and WHEREAS, Grantor is willing to grant to Grantee an easement for ingress and egress over the Servient Estate for said purposes under the terms and conditions set forth herein. Agreement NOW, THEREFORE, for and in consideration of the sum of Ten Dollars ($10.00) and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, Grantor does hereby grant, bargain, sell, and convey unto Grantee, its successors, and assigns, a non-exclusive easement for ingress and egress (the "Easement") over, under, and across the Servient Estate, as more particularly described and depicted in Exhibit C attached hereto and incorporated herein by reference (the "Easement Area"), subject to the following terms and conditions: 1. Purpose. The Easement granted herein is for the purpose of providing Grantee with access to the portion of the septic field located on the Servient Estate, including the right to enter upon the Easement Area to inspect, maintain, repair, and replace any portion of the septic field as necessary. 2. Term. The Easement shall be perpetual, running with the land and binding upon Grantor and Grantee and their respective successors and assigns. 3. Maintenance and Repair. Grantee shall, at its sole cost and expense, maintain the Easement Area in a good, safe, and sanitary condition, and shall promptly repair any damage to the Servient Estate caused by Grantee's use of the Easement. 4. Indemnification. Grantee shall indemnify, defend, and hold harmless Grantor from and against any and all claims, damages, losses, liabilities, and expenses, including �If�ial�l�lf ����I�I`�III�UsIf�!�II�GNI�I����� �I SII Page 2 of 3 301-2024-016017-0 reasonable attorneys' fees, arising out of or related to Grantee's use of the Easement Area. 5. Non -Interference. Grantor agrees that it will not erect or place any structure, fence, or other obstruction on or within the Easement Area that would interfere with Grantee's use of the Easement for the purposes stated herein. 6. Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of Alaska. 7. Entire Agreement. This Agreement constitutes the entire agreement between the parties with respect to the subject matter hereof, and supersedes all prior and contemporaneous agreements and understandings, whether written or oral, relating to such subject matter. 8. Amendments. This Agreement may not be amended or modified except by a written instrument executed by both Grantor and Grantee. IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day and year first above written. Grantor: Karen Coombs-Marcey, as Trustee of the Karen Coombs-Marcey Revocable Trust Karen Coo ce y, Trustee Grantee: [Name of Grantee/Ownerf)Shadowbrook Lot 1] By: [Name], (Title] Notary Acknowledgment State of Alaska County of On this 2t S_�day of .J6+ t , 2024, before me, the undersigned notary public, personally appeared Karen Coombs-Marcey, known to me to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same in her capacity as Trustee of the Karen Coombs-Marcey Revocable Trust. In witness whereof, I hereunto set my hand and official seal. , o '+ r;�0�` .•�� 31 bls•. �� a .51 �118 cn ; n� ©�'•�: ,gyp/ y Page 3 of 3 301— 2024-016017— 0 Municipality of Anchorage Community Development Department Page 1 of 4 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP161068 PID Number: - 015-492-07 ❑ New ❑✓ Upgrade Name: Karen Coombs-Marcey ABSORPTION FIELD ❑Deep Trench ZShallow Trench El Bed Q Mound ❑ Other Address 11300 Mael Street, Anchorage AK 99516 Phone _ Number of Bedrooms Soil Rating Total depth from original grade 3 1.0 GPDrsF 2.O Ft. LEGAL DESCRIPTION - Depth to pipe invert from original grade +1.5 Ft. Gravel depth beneath pipe - 0.5 FL Subdivision Block Lot SHADOWBROOK 2 Fill added above original grade -1.0 Ft. Gravel length 90 Ft. Township Range Section Gravel width 5Ft. Beds: Number of Lines 0 Distance between lines 1 0Ft. SEPARATION DISTANCES Tc From Septic Tank Absorption Field Lift Station Holding Tank Sewer Line Total absorption area 450 Ft2 Number of trenches - 2 Dist. between trenches - 1 OFt. Well N/A 111.2 N/A N/A 50+ TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity I Surface water N/A 100+ N/A N/A Gal. Material - Number of compartments Lot Line N/A 28.5 N/A N/A NA Foundation N/A 63.6 N/A N/A LIFT STATION Manufacturer - Capacity - Curtain Drain N/A 50+ NIA N/A Gal. Remarks Pump on level at in. Pump off level at - in: High water alarm at In. - Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL House to tank 3034 Tank to drainfiield 3034 John's Excavating Drainfield 3034 COIMT 3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 100ft Inspection �, dates: 5/2/2016 2" 5/3/2016 e 5/17/2016 0 Location and description - Bottom Trim NE Corner COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval Date.Q 'rg�Q(�G�, * 49TH *�l ` teven Flan+tome E 49 Approved Datec$1� inspection Repor—-1-12.eoc A B \ s T1 .6 10.4 2 DCO 10.2 16.7 - / - DV 59.2 48.2 - �O -------_---------- - - - - - - FS 64.8 61.0 _ C01 - 69.8 64.9 10 - - - ----------------_ — MT1 72.9 � 68.2 — — — — — — — --- - 0O2 114.1 105.7 INSTALLED ABSORPTION FIELD_. _ MT2 113.5 105.9 3� (2EA) 45LFx5.0'WxO.5'E.D., 2.0'T.D. CO3 75.3 -74.6 W/ 2.0' SAND FILTER, 2" RIGID INSULATION, COs AND MTs AT BOTH MT3 75.8. 74.4 ^ ENDS OF EACH TRENCH. ADD 1.0' C04117.4 111.7 \3% 1 COVER ABOVE GRADE WITH 3:1 SIDE MT4 116.0- 110.1 ^,5`9 Mia SLOPES C04 39.3 MT22 2B.5 - \3^y J CO3 TH-1 V / MT3 0 MT7. 4 t1 Col F°V FS 3 l vI �9 1M REPAIRED DCO \kl -� T7 B N 3 BR \ SFD ED INTEGRITY OF 1000g SEPTIC TANK (E) REPAI ED CO 10' W _ NOTES: DRAWNIJRL SITE PLAN 7i WELL E ` 1 � c Esmt 1 / ele & I Iec Esmt W BUBBLING BROOK C \yk _/ - — — — — I UE NORTH 0 SCREE : 1"= 50' /1 PANNONE ENG SVC, LLC P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 * :* Date 5/31/16 Scale i" = 50' P.I.D. NO ..... .. ... SHADOWBROOK L2 COOMBS-MARCEY KAREN REV TRUST 11300 MAEL ST even R onnORe CE 8149 015-492-07 PERMIT N0. osPlslosa sheet ANCHORAGE, AK 99516 2 OF 1000 g SEPTIC TANK (E) TRENCH 2:87.42 TRENCH 1:87.58 TRENCH 2:86.92 PROFILE DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM NO. BEDROOM: 3(450 gpd) TANK SIZE: 1000g PERC RATE: <1 MPI SOIL RATING: 1.0 GPD/SF AREA ROD: 450 SF SYS. TYPE: WIDE TRENCH 0.5'ED MIN LENGTH: 90 LF USE: (2EA) 45.OLFx5.0'WxO.5' E.R.; 2.0' TD, W/ 2.0' SAND FILTER TOTAL AREA: 450 SF ABOVE PIPE INV 45.0 2: 87.42 '.H 1:87.58 H 2:86.92 w —w —WATER LINE / WELL RADIUS ss ss — NEW SEPTIC 3:1 SIDE SLOPES VEGETATED TH-1 2.0 99 0 ax GP 96.0 GM 90.4 82.0 ABBREVIATIONS TH W (P) PROPOSED ti 0 U� o LL—W1 > j k m 0 w z 0 1000 g SEPTIC TANK (E) TRENCH 2:87.42 TRENCH 1:87.58 TRENCH 2:86.92 PROFILE DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM NO. BEDROOM: 3(450 gpd) TANK SIZE: 1000g PERC RATE: <1 MPI SOIL RATING: 1.0 GPD/SF AREA ROD: 450 SF SYS. TYPE: WIDE TRENCH 0.5'ED MIN LENGTH: 90 LF USE: (2EA) 45.OLFx5.0'WxO.5' E.R.; 2.0' TD, W/ 2.0' SAND FILTER TOTAL AREA: 450 SF ABOVE PIPE INV 45.0 2: 87.42 '.H 1:87.58 H 2:86.92 w —w —WATER LINE / WELL RADIUS ss ss — NEW SEPTIC 3:1 SIDE SLOPES VEGETATED TH-1 2.0 99 0 ax GP 96.0 GM 90.4 82.0 ABBREVIATIONS TH TEST HOLE (P) PROPOSED (E) EXISTING CO CLEAN OUT NO. MT MONITOR TUBE NO. TYP TYPICAL NOTES: PANNONE ENG SVC, LW P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 *:� :* e 4iW *A. °""O"° CE 8149 Date 31/16 RECORD DRAWING Scale i" = 10' SHADOWBROOK L2 COOMBS—MARCEY KAREN REV TRUST 11300 MAEL ST ANCHORAGE, AK 99516 P.I.D. NO 015-492-07 DRAWN JRL PERMIT NO. OSP161068 SITE PLAN sheet 30F3 On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP161068 Tax Code Number: 01549207000 Work Type: Septic Upgrade Permit Effective Dates: April 25, 2016 to April 25, 2017 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: SHADOWBROOK Site Legal Address: SHADOWBROOK LT 2 G:2638 Owner/Address: COOMBS-MARCEY KAREN REV TRUST COOMBS-MARCEY KAREN/TRUSTEE 11300 MAEL ST ANCHORAGE AK 995161804 Site Mailing Address: 11300 MAEL ST, Anchorage Lot Size in Sq Ft: 50734 Total Bedrooms: 3 This permit is for the construction of: Y Disposal Field N Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By By Date:1� Date: MUNICIPALITY OF ANCHORAG Community Development Department Pho°e 9cJ7-94�-�441� Development Services Division F 907-343-7997 On-Site Water & Wastewater Program z ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-492-07 Property owner(s) Coombs-Marcey Karen REV Trust Day phone Mailing address 11300 Mael St, Anchorage, AK 99516 Site address 11300 Mael St, Anchorage, AK 99516 Legal description (Sub'd., Block & Lot) SHADOWBROOK L2 Legal description (Township, Range & Section) Lot Size 50,734 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑ Upgrade ❑X Duplex (D) F]Holding Tank F-1Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE ! WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 15(00(— Date of Payment: H-11-1 (P Receipt Number: 0b308G Permit No. OSP 1 So WO (o$' Permit App_::- : Waiver Fees: Date of Payment: Receipt Number: Waiver No. Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: Steve@panengak.com April 11, 2016 Subject: SHADOWBROOK L2 Septic System Upgrade Permit Request Design Narrative This is a design narrative for a permit to install an upgrade septic system to be issued for this property. The proposed systems will serve an existing three (3) bedroom house. Currently the lot is developed. The existing drain field is in failure and will be re -used as a reserve. The system will utilize an existing 10008 septic tank and new conventional drain field. This lot and the surrounding lots are served by private wells. There are no wells within 100' of the proposed septic system 1. Soils. One test hole was performed in the vicinity of this system by Pannone Engineering Services in March 2016, and groundwater was monitored for at least seven days. Ground water was not observed to a depth of 9.6' below the surface in the test hole monitor tube in April 2016. Bedrock was not encountered in the test hole. Both predominate soil layers were perc tested. Based on the results of the percolation tests and overall soils appearance; an application rate of 1.0 gallons/day/square was used for a conventional wastewater system in the area of these test holes. 2. Soil Absorption System Design. a. See Sheet 1 of the design package. 3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 4. Topography: The existing topography slopes from the east to the west at approximately 3%-5% in the area of the septic system. There are no steep slopes within 50' of the proposed drain field. The proposed drain field will maintain 50' separation all, steep slopes. 5. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that the review is complete and that there are no further comments is received from MoA On -Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of this or the surrounding lots. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 10' U—ti l Esmt _ �_ _ INSTALL ABSORPTION FIELD (P) 351'0 (IEA) 45LFx5.0'Wx0.5'E.D., 2.0'T.D. -� W/ 2.0' SAND FILTER, 2" RIGID INSULATION, COs AND MTs AT BOTH _ ENDS OF EACH TRENCH. ADD 1.0' y 39 COVER ABOVE GRADE WITH 3:1 SIDE 1 �Sg SLOPES 35 h 1 0.0 TH-1 3g � l` 1 vr FSP i Q Q 1l COATRACTOR WILL DV(P) U VERIFY INTEGRITY OF SE�TIC LINE (E) REPAIR D�) N� VERIFY INTEGRITY OF 10009 SEPTIC TANK (E) \ Kth'HIKO GUFF') 7 �I E ` 1 � 10T eI & Elec Esmt /— W -----/BUBBLING BROOK Cir — — — — — —Date NOTES: PAMONE ENG SVC, IM P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 • *: :* ..... . . .. ... $3°ve" °""OR° CE 8149 j 04/20/16 FOR CONSTRUCTION scale 1" = 50' SHADOWBROOK L2 COOMBS-MARCEY KAREN REV TRUST 11300 MAEL ST ANCHORAGE, AK 99516 P.I.D. NO 015-492-0 DRAWN JRL PERMIT N0. osPlsloss SITE PLAN sheet 1 OF 5 1000 g SEPTIC TANK (P) PROFILE DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM NO. BEDROOM: 3(450 gpd) TANK SIZE: 1000g PERC RATE: <1 MPI SOIL RATING: 1.0 GPD/SF AREA ROD: 450 SF SYS. TYPE: WIDE TRENCH 0.5'ED MIN LENGTH: 90 LF USE: (2EA) 45.OLFx5.0'WxO.5' E.D., 2.0' TD, W/ 2.0' SAND FILTER TOTAL AREA: 450 5F 45.0 —WATER LINE / WELL RADIUS — NEW SEPTIC SLOPES 2.0 FWAV011-41-41TWAVIllows TH W 7 (P) PROPOSED (E) EXISTING CO H F MT MONITOR TUBE NO. TYP TYPICAL - PERMIT NO. OSP161068 DRAWN JRL w'o � DRAIN ROCK 6" 0 c� 3 W ABOVE PIPE INV 0 fg�11 fn7 H 4" 6 D� o LLIl_ � 1000 g SEPTIC TANK (P) PROFILE DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM NO. BEDROOM: 3(450 gpd) TANK SIZE: 1000g PERC RATE: <1 MPI SOIL RATING: 1.0 GPD/SF AREA ROD: 450 SF SYS. TYPE: WIDE TRENCH 0.5'ED MIN LENGTH: 90 LF USE: (2EA) 45.OLFx5.0'WxO.5' E.D., 2.0' TD, W/ 2.0' SAND FILTER TOTAL AREA: 450 5F 45.0 —WATER LINE / WELL RADIUS — NEW SEPTIC SLOPES 2.0 FWAV011-41-41TWAVIllows TH TEST HOLE (P) PROPOSED (E) EXISTING CO CLEAN OUT NO. MT MONITOR TUBE NO. TYP TYPICAL - NOTES: PAMONE ENG SVC, � •�x , P.O. BOX 102954 ANCHORAGE, AK 99510' PHONE (907) 272-8218 FAX (907) 272-8211 " " •. �y *:• :* .. .. .. ... Pcnnolie CE 8149 Da te 04/20/16 FOR CONSTRUCTION Scale _ 1" = 10' - SHADOWBROOK L2. COOMBS—MARCEY KAREN REV TRUST 11300 MAEL ST ANCHORAGE, AK 99516 P.I.D. NO 5-492-07 PERMIT NO. OSP161068 DRAWN JRL SITE PLAN Sheet 2 OF TEST HOLE 1 PERC TEST 1 OR TOPSOIL SOILS LOG — PERCOLATION TEST SLOPE TEST HOLE WAS GROUND WATER ENCOUNTERED? Y IF YES AT WHAT DEPTH? –17.5'– DEPTH TO 7.5'–DEPTHTO WATER AFTER - MONITORING? –9.67'– DATE: 30MAR2016 06APR2016 READING GATE CLOCK TIME NET TIME WATER LEVEL READING Brown Silty 2 GP SAND & P.I.D. NO 015-492-07 GRAVEL 3 DRAWN JRL 2 4 10 MIN 11.161" S 2.04" 3 6 7 4 GM Silty Sandy 8 17.024" Gravel 9 5 1049 ----- -------- 30MAR2016 1C — 06APR2016 11 1 10 MIN 12 4.760" 2.10" 13 14 15 16 17 18 — BOH DATE PERFORMED: 24MAR16 SOILS LOG — PERCOLATION TEST SLOPE TEST HOLE WAS GROUND WATER ENCOUNTERED? Y IF YES AT WHAT DEPTH? –17.5'– DEPTH TO 7.5'–DEPTHTO WATER AFTER - MONITORING? –9.67'– DATE: 30MAR2016 06APR2016 READING GATE CLOCK TIME NET TIME WATER LEVEL READING NET DROP RATE (MPI) 1 24MAR16 1026 P.I.D. NO 015-492-07 6.268" PERMIT NO. OSP161068 DRAWN JRL 2 1036 10 MIN 11.161" 4.893 2.04" 3 1037 6.268" 4 1047 10 MIN 17.024" 4.756" 2.10" 5 1049 6.268" 6 1 1059 1 10 MIN T 11.028" 4.760" 2.10" TH 1 SOIL TEST RESULTS /ANALYSIS • PERCOLATION RATE 2.1 (minlinch) (Hydrologic Soils Group: HSG A) • PERC HOLE DIAMETER 6" • TEST RUN BETWEEN 6 FT AND 7 FT. • TEST RUN FOR OVER AN HOUR, LAST THREE READINGS PROVIDED. COMMENTS: Test hole excavated by John's Excavating. Test Hole was presoaked before Perc test. PERFORMED BY: Joseph Lawendowski. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. NOTES:LLC L C P.O. ENG SVC, I.I,C P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 �•' ' '••.•• *:49 .* .... .. ... ... 1'everi'li. annoie' CE 8149 Date - 04/20/16 FOR CONSTRUCTION Scale NTS SHADOWBROOK L2 COOMBS—MARCEY KAREN REV TRUST 11300 MAEL ST ANCHORAGE, AK 99516 P.I.D. NO 015-492-07 PERMIT NO. OSP161068 DRAWN JRL SITE PLAN Sheet 30F5 TEST HOLE 1 PERC TEST 2 FORTOPSOIL SOILS LOG — PERCOLATION TEST SLOPE TEST HOLE WAS GROUND WATER ENCOUNTERED? Y- IN YES AT WHAT DEPTH? —17.5'— DEPTH TO WATER AFTER MONITORING? —9.67'— DATE: 30MAR2016 06APR2016 3�SITE PLAN 3�g READING DATE CLOCK TIME NET Brown Silty 2 NET DROP GP SAND & 1556 GRAVEL 3- 2 1559 3.6 4- 45 DRY 6.0" 0.60 3 1600 5 6.260" 6 1603 3.1 MIN DRY 7 0.52 5 1604 GM Silty Sandy 8 6 1607 Gravel 9 ORY 6.0" 0.50 -------- 30MAR2016 10 06APR2016 11 12 13 14 15 16 17 18 — BOH DATE PERFORMED: 06APR16 SOILS LOG — PERCOLATION TEST SLOPE TEST HOLE WAS GROUND WATER ENCOUNTERED? Y- IN YES AT WHAT DEPTH? —17.5'— DEPTH TO WATER AFTER MONITORING? —9.67'— DATE: 30MAR2016 06APR2016 3�SITE PLAN 3�g READING DATE CLOCK TIME NET TIME WATER LEVEL READING NET DROP RATE (MPI) 1 06APR16 1556 6.260" 2 1559 3.6 MIN DRY 6.0" 0.60 3 1600 6.260" 4 1603 3.1 MIN DRY 6.0" 0.52 5 1604 6.260" 6 1607 3.0 MIN ORY 6.0" 0.50 TH-1 SLOPE TH 1 SOIL TEST RESULTS /ANALYSIS • PERCOLATION RATE 0.5 (minlinch) (Hydrologic Soils Group: HSG A) • PERC HOLE DIAMETER 6" • TEST RUN BETWEEN 2 FT AND 3 FT. • TEST RUN FOR OVER AN HOUR, LAST THREE READINGS PROVIDED. • HAND DUG TEST HOLE VIC TH-1 COMMENTS: Test hole excavated by John's Excavating. Test Hole was presoaked before Perc test. PERFORMED BY: Joseph Lawendowski. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. NOTES: DRAWN I JRL I SITE PLAN PANNONE ENG P.O. BOX 102954 ANCHOR PHONE (907) 272-8218 FAX .. Da 04/20/16 995109510�'•" 272-8211 ** Scale TH NTS o i n nin SHADOWBROOK L2 COOMBS—MARCEY KAREN REV TRUST 11300 MAEL ST ANCHORAGE, AK 99516 `8,149: L (PERMIT NO. CE jI OSP161068 4 OF SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON—SITE WASTEWATER DISPOSAL SYSTEMS AND AND IN ACCORDANCE WITH AMC 15.65 AND 15.55. 2. SCOPE OF WORK: VALIDATE INTEGRITY OF SEPTIC TANK(E), REPAIR TANK CO AND DCO, INSTALL SOIL ABSORPTION SYSTEM. 3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 9.6 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 9.6 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. 4. THE CONTRACTOR (BOTH WELL AND SEPTIC SYSTEM CONTRACTORS) SHALL HAVE ANY WELL LOCATION AND SEPTIC LOCATION STAKED AND ANY LOT LINE AND WELL RADIUS SHOWN ON THE PLAN WITHIN 30 FEET OF THE PROPOSED SYSTEM STAKED BY A REGISTERED LAND SURVEYOR BEFORE STARTING THE WORK. 5. THE CONTRACTOR IS RESPONSIBLE FOR ALL R.O.W. AND OTHER REQUIRED PERMITS, OTHER THAN THE ATTACHED, 6. THE CONTRACTOR SHALL CALL FOR LOCATING OF ALL BURIED UTILITIES. 7. THE CONTRACTOR SHALL PROVIDE 24 HOUR NOTICE TO THE ENGINEER PRIOR TO START OF WORK. ALL SURVEYING AND LOCATES SHALL BE IN PLACE PRIOR TO NOTIFYING THE ENGINEER. 8. THE CONTRACTOR SHALL NOTIFY THE ENGINEER OF ANY DISCREPANCY BETWEEN THE APPROVED DRAWINGS AND SITE CONDITIONS/LIMITATIONS POTENTIALLY CAUSING THE NEED TO MODIFY THE DESIGN. 9. AT THE COMPLETION OF THE WORK, THE CONTRACTOR SHALL SUBMIT RED—LINE AS—BUILT DRAWINGS TO THE ENGINEER. THE RED—LINES SHALL INCLUDE PIPE LENGTHS, ORIGINAL GROUND ELEVATIONS, PIPE ELEVATIONS, AND TANK ELEVATIONS. 10. THE CONTRACTOR SHALL PROVIDE PHOTOGRAPHS OF THE SYSTEM INSTALLATION TO INCLUDE BOTTOM OF EXCAVATION, TOP OF PIPE WITH CLEAN—OUTS AND MONITOR TUBES INSTALLED, INSTALLED TANK AND FINAL GRADING. 11. THE CONTRACTOR PROVIDED DATA (UPON WHICH THIS RECORD DRAWING IS BASED) APPEARS TO REPRESENT THE PROJECT AS CONSTRUCTED. THIS DATA IN CONJUNCTION WITH THE PERIODIC FIELD OBSERVATIONS BY THE ENGINEER (OR HIS DESIGNEE) AS REQUIRED BY AMC 15.65 DOES NOT GUARANTEE THAT THERE ARE NO HIDDEN DEFECTS BY THE CONTRACTOR. 12. THE CONTRACTOR SHALL SIGN THE FOLLOWING: I CERTIFY THAT ALL WORK WAS PERFORMED IN ACCORDANCE WITH THE APPEND PERMIT, AND ANY AND ALL CHANGE ORDERS, AND THAT THE AS—BUILT REDLINES ARE TRUE AND ACCURATE REPRESENTATION OF THE PROJECT AS CONSTRUCTED. CONTRACTOR: TITLE: NOTES: PANNONE ENG SVC, LLC FOR CONSTRUCTION P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 SHADOWBROOK L2 DRAWN JRL COOMBS-MARCEY KAREN REV TRUST 11300 MAEL ST SITE PLAN ANCHORAGE, AK 99516 im- 04/20/16 Scale NTS "CE"8749 '* S(PERMIT N0. A# OSP161068 5 OF MUNICIPALITY OF ANCHORAGE ® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME 7!;; PHONE ❑NEW UPGRADE MAI LING ADDRESS S /Z4 LEGAL DESCRIPTION / ���� -� �t,! 1' S o23 7/ -U LOCATION NO. OF BEDROOMS ROOMS Uy DISTANCE TO: Well Absorption area Dwelling PERMIT NO. F Z aQ wF Manufacturer Material No. of compartments rn Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth 0 y JUZ DISTANCE TO: Well Dwelling PERMIT NO. 02 h Manufacturer Material Liquid capacity in gallons o w = DISTANCE TO: Well Foundation Nearest lot line PERMIT O. / p ,,eV J LL z Z w I- - No. of lines / Length of each line Total lengt�of Ines , Trench width JO inches Distance between lines !i1 cc f.. 0 Top of tile to finish grade / 1f Material beneath tileTotal U Q- inches effective absorption' area 577 ,Q w Length Width Depth PERMIT NO. 0 Q F w 1 Type of crib Crib diameter Crib depth Total effective absorption area WWell W DISTANCE TO: Building foundation Nearest lot line J J Class Depth Driller Distance to lot linePERMIT NO. W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS Y�l2sfiC SOIL TEST RATING INSTALLER 54 A REMARKS ®wt ie>nal /c+s � 3 1-411 F _sd APPROVED DATE LEGAL SL A)kJj Se'E--LL lVtJ- .523 7-/2,4j 1Z3ta 5� 72-013 (Rev. 3/78) 0"1 R.J r - _R 1 A_.- 1 o� [•-'i L_ 1 7.r a CH F_ F_g P_4�� {"A." ��A F;r F'' q 7l E DEPARTNEP-IT HEALTH AND ENVIRONMENTAL ;OTECT I ON 825 'L'' STREET, ANCHORAGE: Al::'. 99501 264-4720 -1 -Ir EE E t.,A EE ➢ TM A__9 ire PERMIT NO. 81071A, 1A, APPLICANT TECH '_�I:� HULTZ E,CI;<, 22 ERA 99507 3443831 831 LOCATION MAEL DR LEGAL Sle':'P•dld:�.�'4 E1.:''4Nttllr'4•S2--T::L',='NR--: kI LOT SIZE H.0CIku00 SQUAREFEET TYPE CIF SOIL ABSORPTION SYSTEM IS: TRENCH MA"': I MUM NUMBER CIF' BEDROOMS = _ SOIL RATING (S]--.! F'T,`BR i =: 1r�: THE REQUIRED SIZE I 'E OF THE SOIL ABSORPTION _ Y,_sTEM I S : THE LENGTH DIMENSION I S THE LENGTH I N FEET".1 OF THE TRENCH OR DRA I NF I ELD. THE DEPTH OF A TRENCH OR PIT 15 THE DISTANCE BETWEEN THE SURFACE OF THE: GROUND AND THE BOTTOM OF THE EXCAVATION r•: I P•I FEET). THERE IS NO _.ET I 4 I DTH FOR TRENCHE:'_>. THE GRAVEL DEPTH IS 'THE MINIMUM DEPTH OF GRAVEL BETWEE tl THE OUTFAL.L F'IF'E AND THE BOTTOM OF THE E;>;C:AVATION Ind F'E:ET). F ° L_¢ I F._ fE IE -d H. FE IF' 1'" 1 C -F � j° -_j ¢ --_ �a � �. � � � �-� a_ � a�a r� ff=9 [ _ � _ ��e �°-3 PERMIT APPLICANT HAS THE REE.F'CIP•d -'IFILI T Y TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIClNS OF ANY I.,IELL 'c:; ADJACENT TO 'THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. .r °.t a=6 A-..2 " I PA �F4=° EF_ C,- ..T I N= -I Lam- F -E rl m° E=DC7a U I F=° F:�C=" _ BAC: -`,F" I LL I NG OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL FIND ANY ON-SITE SEWAGE DISPOSAL. S'r STEM IS I_k' 0 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING t-fF'ON THE TYPE OF PUBLIC I`.IEL.L. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS .25 FEET AND TO A COMMUNITY SEb!ER L I NE: IS 75 FEET. OTHER REQ I I REMENTE• MAY APPL'r'. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. I I.:EE=:I"IF'•r' THAT I AM F'AM I L. I AR WITH THE REQ II_t I REC'1ECdl" = FOR ON - SITE SEWERS AND WELLS A'_ SET Ft R"m BY THE MUNICIPALITY OF ANCHORAGE. _ : I WILL INSTALL T'HE SYSTEM IN ACCORDANCE WITH THE CODES. -:: I UNDERSTAND D THHT THE ON-SITE SEWER SYSTEM TEM Mff-' REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 33: BEDROOMS. 'APPLICANT TFCC .. CF- ULTZ i`;E;1_IES:AL`-Ir._.„...�__.,r__...___...._�____.__ W. G t � F W. G O & E ENC.,NEERING & DEVELG. `MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster 694-2774 Performed for: Legal Description Depth (feet) SOIL LOG Earl Ellis 688-2280 Name: ✓'Y� , �fU .EIc-�1Z a Tel. No.'SgLI'38*3/ Mailing Address: Soil Characteristics 0 1 2 ® 3 ici — AAj oy L 4 5 �% 7 8. 9. 10 11 12 13 14 15 rirw- f!�,4-:gy 9 4� PLOT PLAN 47 PERC. TEST CIia M1,JIme-, a :�>dp 4:1,6cri- 16 6�1� Ground Water Encountered: Yes No If yes, what depth Proposed Installation: Seepage Pit- Drain Field � Comm Performed by: Russcil L. Gy5 No. 4;286 Dater `��• / no � � r Russcil L. Gy5 No. 4;286 Dater `��• / no MUNICIPALITY OF ANCHORAGE Development Services Department .......... Phone: 907-343-7904 On -Site Water & Wastewater Section V l Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I. D. 015-492-07 Legal description SHADOWBROOK LT 2 Site address 11300 MAEL ST Anchorage AK 99516 Current property owner(s) KAREN COOMBS-MARCEY Expiration Date: 10/4/2024 X The On -site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 7/23/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUNICIPALITY OF ANCHORAGE ....... . . . . . ........... Development Services Department Phone- 907-343-7904 On -Site Water & Wastewater Section Fax- 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-492-07 Complete legal description Shadowbrook Lot 2 Location (site address) 11300 Mael Street Current property owner(s) Karen Coombs-Marcey Rev Trust Day phone 2. ON -SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: OR Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: OR Private Septic ❑ Private Septic serving 2 dwelling units F_ Holding Tank n Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑ Plastic Al Concrete ❑ Fiberglass Age 57 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench 0 Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On -site staff to verify the accuracy of the information provided. COSA Fee $ Date of Payment COSA# Waiver Fee $ Date of Payment Waiver # COSA ApplicationJune2022 COSA Checklist_June 2022 COSA Checklist Legal Description: Parcel ID: If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank Date of pumping Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Adequacy test date Results Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) in Effective depth used in Effective depth remaining in Comments/Deficiencies: COSA Checklist_June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F.ENGINEER’S COMMENTS G.CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC & MOA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail, and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore, we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Phone Engineer’s Printed Name Date Lot 3 z o• Lot 3A C'I J Lot 2 S 89'57'36"E 165.34' 10' T&E EASEMENTS Lot 2 SEPTIC PI 8.5' x / .0' 6.0' x 14.0' / BALCONY 2.8' x 16.5' CANT 2.8'- i Lot 1 I Lot 1 -� ) U% SEPTIC PIPE$ \ CHAIN -LINK FENCE N LA 4. N \16.0' x 18.5' DECK 61.0' \ RADkus OTECTNE WELL ..'.100 pR I 1 Wr H '- 2.8' L 5.5' x 12.0' :.. 2.5' DECK 2.0' x 6.0' CANT ' 5.1' x 8.9' BALCONY GRAVEL L=17.74' / R=50.00' L=39.77' R=50.00' N 89'58'09"W 119.85' o 04 / o BUBBLING BROOK CIRCLE NOTES: THE STRUCTURE IS A ONE STORY RESIDENCE WITH A WALKOUT BASEMENT. THE DRIVEWAY CROSSES LOT 1 AND EXITS ONTO MAEL STREET. SEPTIC PIPES FROM ADJACENT LOT 1 ENCROACH ONTO LOT 2 AS SHOWN. PLOT PLAN ___ AS BUILT _X_ SCALE _1= 40__ GRID _ SW 2638Project No. J24=041161 P.O. Box 210005 Lang & Associates, i n C Anchorage, Alaska 99521-0005 Q000pp� Professional Land Surve (907) 592-64y6 ors �/ ken®Iansurve com c)F AC0004 � •,• 4 jonathan®langsurvey.com I hereby certify that I have surveyed the following described property: LOT 2, SHADOWBROOK SUBDIVISION (Plat No. 81-322) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the z? Day of _ SJ ________,Y'�4 ; at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. p JONATH C,JLANG .• o ;g� • Z 3' LsG24�S •.L 9944.• ' c,JpG 40o OFESSIONAN- State of Alaska AECC963 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH f �n —7 o CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL 4 / — �ZS�'<z OF ON-SITE SEWER AND WATER FACILITY 264-4720 9 Application Date 4� 1. GENERAL INFORMATION (a) Le al Description (include lot, block, subdivision, section, township, range ,,�, ,,.� I4F 'T o 8341 Sor�3 51Ia n1 W% SE Y4 Location (address or directions) (b) Applicant Name K;4 Telephone: Home �`{7�'j('�Business Applicant Address —/ (c) Applicant is (check one): Lending Institution 11; Owner/builder Ifa'; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Address (e) Real Estate Company and Agent Address Telephone (f) - Mail the HAA to the following Telephone 3 C --, -c ITt%- ir5b TTN �in11 wtF �{rvl=2 2. TYPE OF RESIDENCE Single -Family U Multi -Family ❑ Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well u/ Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGEDI OSAL Onsite Public O Oommunity O Holding Tank M Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11i84) Wn 0 SZO-zz Z 10 Z abed •>!jom s,jaau!bue !euo!ssatojd aq1 ui suo!ss!wo jo sjolja jol apsuodsw lou si a6ejogouy to (1!!ed!o!unVy aq1 'panss! si aleoil! iao a wolaq elep azAleue jo suo!loadsui lonpuoo lou op d3H0 to se@Ao!dui3 •sluawal!nbaj alels pue !ejapal u!eljao /ts!les of japjo u! suognl!lsu! 6u!pua! j!agl pue sawoq to sjasegojnd of (seljnoo a se s!ql saop d3H0 941 'e�!se!y 10 alels aq1 u! pajals!6aj laau!6ua !euo!ssalojd luapuadapu! ue Aq anoge 9 ydeirmied u! UGA16 suo!leluasajdaj aq1 uodn Alalos paseq saleo!1!1aa0 !enojddy Al!jogtny g1!eaH sanss! (d3Ha) uopoalojd !elu9wuoj!Au3 pue g1!eaH to luawl.iedad abejogouy to Aj!!ed!ounN aq1 NOI nvo !enojddy !euo!l!puoO to swjal !euo!1!puoO panolddes!Q panoaddy �y eje4 Aq swoojpaq 101 panoaddy Y441 A� IVAOtlddd d3Ha '9 - leas s,jaau! n ` .1 P algid SSqjppv �S 1 9_ 119S7 ouogda!al -Dw1!d 10 aweN vo!10a su! s!141 to alep a14l uo loalla ui suo!le!n6aj pue 'saoueu!pjo 'sapoo al.els pue !ed!o!unW !ie ql!M aoue!!dwoo ui s! wags (s !esods!p jejumalsem jo/pue A!ddns jeleM a1!s-uo aql 'uo!loadsui pue uo!1e611sanu! Aw wojt pue sa!!t e6ejogouy to l!!ecipunW eql wojt pau!elgo uo!lewjotui aq1 uo paseq legl Al!J9A jagllnl ! •u!ajaq pa1e0!pu! aanlonals to adAl pue swooapaq to jagwnu aql jot alenbapepue!euo!Fount'aless!walsls!esods!pjolemolsumjo/puet!ddnsjalemal!s-uoa14lleglsmogs!enojddy tl!joglny gl!eaH s!q1 to uo!lebpsanu! Aw 1eg1 ApJOA ! 'ano!aq urnogs alep uo!1ep!!eA eql to se pue 0191014 paxllte leas (w Aq pa!lpjao sy NOI1yWHOdNI (INV d1Na `HOUIV3S Slid `S1S31 `SNO11O3dSNl JNIaIAOHd W!!I3 °JNI!13314IJN3 .9 MuNICIF 4f 11y of ANEF1e> ASB ENviRoNM NTAI st v1E35 ®1V1 19P1 A. WELL D* MUNICIPALITY OF ANCHORAGE (MOki HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 `A_ Legal Description: "Otr'ogk_ 1 02 T JaN RZW �Wc673 6 /a )Q W ©4 5E f/4 Well Classification If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) _P.IV Date Completed tom• 1%7 � Yield �Q flM1'1 Total Depth Cased to �r Depth of Grouting lynown ��� Static Water Level /1 Pump Set At Casing Height Above Ground �! Sanitary Seal on Casing (Y/N) 0 as Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/NP !V© Separation Distances from Well: ! To Septic/Holding Tank on Lot 5Q ; On Adjoining Lots e To Nearest Edge of Absorption F`ierld on Lot 107 ; On Adjoining Lots — To Nearest Public Sewer Line 'U /A To Nearest Public Sewer --f"' / 150 "f 15-01 Cleanout/Manhole N To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Resultts, Comments T1s L m B. SEPTIC/HOLDING TANK DATA ; Date Date Installed qtt L� Size 10000 , .No. of Compartments AffloWn Standpipes (Y/N) , pAir-tight Caps (Y/N) Foundation Cleanout (Y/N) f `) Depression over Tank (Y/N) 1VC •• (( cJ Date Last Pumped a qA ��! 7 Pumping/Maintenance Contract on File (Y/N) IV I ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: 9� To Water -Supply Well S©1 � To Building Foundation To Property Liney75l To Disposal Field 61 To Water Main/Service Line Course +100' Comments *-Or igf n4 bta� t Yhtt1_� ✓ j-mf`/V6lrin _ SlJfw'rY'iVaiYdl To Stream, Pond, Lake, or Major Drainage n;9e 1 pf 2 iMt-1�-QTS A_z.e...'Y�u c�--�Z_ �o r�. D� A96 . qo 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �� (G/ Type of System Design Date Installed �L, �d�I Length of Field �• Width of Field Depth of Field (� Gravel Bed Thickness Square Feet of Absorption Area 54 Standpipes Present (Y/N) ,2 Depression over Field (Y/N) t Date of Last Adequacy Test 451._ Results of Last Adequacy Test &(A V\ Separation Distance from Absorption Field: To Water -Supply Well 102t �© (�To Property Line To Building Foundation G©t To Existing or Abandoned System on Lot tA/V 60U)n- ��� On Adjoining Lots +100 1 To Water Main/Service Line p 1 To Cutbank (if present) AFEf4 To Stream/Pond/Lake/or Major Drainage Course I�1 /� ;"NO/ To Driveway, Parking Area, or Vehicle Storage Area �f Comments /X_lZ- f4f'174s f Zfi`��_ don n .! 1 �47 �kz AV D. LIFT STATION Date InstIled Size in G Ions "Pump 0e evel at High Water Alarm el at Tested for Electrical Codes (Y/N) — Comments 4No. _ - ** CheckidI certify t Signed CompanReceipt — Dimensions Manhole/Access(Y/ ) �' "Pump QOif ev�el at d' Vent (Y/N) Pumping Cycles during g Against HAA Request ** Test. Meets MOA or conformed t all MOA and HAA guidelines in effect on the date of this inspection. I i — 6ate U if MOA No. D/ Date of Payment —4 3 d P? Amount: $ 16 Page 2 of 2 72-026 (11/84) C, e �a Br v e•. Corwin m 'tP a o. E-5283 m°°m -�:' •% Engineer's Seal I DATE RECEIVED 5 i• INSPECTION APPOINTMENTS 6. TYPE OF RESIDENCE TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF HEALTH & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PROTECTION • ENVIRONMENTAL SANITATION DIVISION NOV 3 0 3981 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW�I�I DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER + '::3 C_ PHONE �C MAILING ADDRESS t2 -z PROPERTY RESIDENT (If different from above) PHONE 2. BUYER q f r y LC�t-t6,(HL- V PHONE MAILING ADDRESS 3. LENDING INSTITUTION AL_v"5 �-i� �t`eC� LC N\� PHONE 2`14--��lc 1 MAILING ADDRESS 4. REALTOR/AGENT - PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION l4_ NW STREET LOCATION--T-L;�„ Q,-�Cy�} e:�t=-Ci'd\tK�I.U`� ��_N o` '_cccc._ �et�C L T, (cJf=l` U'Mf �lty` ) L%5C—Z t\'f iiZ '=` C.. f\ C lLlACzLCllC-K, \`moi 6. TYPE OF RESIDENCE NUMBER OF,BIEDROOMS ❑ One El Four E] Other { SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER SUPPLY 1. INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM q\�q)6 k i, I ' j,. - INDIVIDUAL/ON-SITE** j�)':j YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line 7 1 Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS L--4PPROVED FOR _ BEDROOMS ❑ CONDITIONAL APPROVAL (letter must ac: mpany certificate) ED DISAPPROVED i DATE 74'� BY 4��_ 'Ad 72-010 (Rev. 6/79)